Dear Spinal Cord reader,

Review of electrodiagnostics: In this issue Nardone et al. reviewed electrodiagnostics in myelopathies. Motor evoked responses (MEPs) represent a highly sensitive and accurate diagnostic tool in many different spinal cord disorders. MEPs can also be useful in follow-up evaluation of motor function during treatment and rehabilitation. In the same line Nardone et al., in an original paper, present electrophysiological evidence of central sensory involvement in a very high percentage of patients with hepatic myelopathy. They point out that central sensory and motor conduction studies are sensitive methods for detecting, localizing, and monitoring spinal cord damage in hepatic myelopathy.

Other diagnosis: Pouw et al. identified in a sample of SCI individuals differences in the structural cerebrospinal fluid biomarkers neuron specific enolase, S-100β, tau, and neurofilament heavy chain between motor complete and motor incomplete SCI patients. Their data showed no clear differences in any of the protein concentrations between the different AIS grades. Quinzanos et al. showed experimentally that the trunk control test they present is valid and reliable. Furthermore, the test can be used for all people with SCI despite the type or level of injury. Wallin et al. determined in three SCI individuals whether individual muscle sympathetic nerve fibers below the level of the spinal lesion display spontaneous activity. They also determined if individual sympathetic vasoconstrictor fibers showed a prolonged discharge following a bladder stimulus. Prolonged discharges in individual sympathetic fibers are unlikely to contribute to long duration blood pressure increases induced by brief bladder stimuli.

Physical exercises, sports: De Groot et al. found faster race times during a 20 km mountain time trial in a handcycle in those with a lower waist circumference, greater fitness level and ability to perform at higher average exercise intensities during the race. Level of SCI was not significantly associated with race time.

Outcome: Osterthun et al. made a prospective multicentre cohort study over a period of >6 years. Twelve percent of persons with SCI who had survived the acute hospital phase died during follow-up of cardiovascular and pulmonary diseases. New and Astrakhantseva, in a retrospective, open-cohort, consecutive case series, showed that patients undergoing initial inpatient rehabilitation after an infectious cause of spinal cord myelopathy returned home with a good level of functioning regarding mobility, bladder, and bowel status and their disability was significantly improved. New demonstrated in a prospective open cohort case series that big opportunities of improvement lay in reducing the time from acute hospital admission till referral to a spinal rehabilitation unit and the time from deemed ready for transfer till admission. Bandari et al. found medical management effective in cervical spine tuberculosis. Patients with significant cord compression and spinal extension of the abscess showed poorer outcome.

Employment: Hwang et al. found that the employment status remained relatively stable in adults with pediatric-onset SCI; however, changes in employment were associated with education, secondary health conditions, and psychosocial well-being.

Urinary and bowel: Yildiz et al. showed retrospectively that the most frequently used technique for bladder rehabilitation in their patients with SCI was intermittent catheterization; the most common anticholinergic drug was oxybutynin; 77% of patients had regular control visits for neurogenic bladder, 42.7% did not experience any urinary tract infection. Faaborg et al. confirmed that bowel and bladder management cause autonomic dysreflexia in high SCI. The response is different depending on the technique used. Liao and Zhang found in a prospective study lumbosacral SCI and chronic indwelling urethral catheterization to be predictors of upper urinary tract deterioration.

There are interesting letters to the editor about important topics. Enjoy reading.